The number of kidney patients is growing every year. There is an urgent need for lifestyle changes, writes Nadia Badarudin

Dr John says more than 60 per cent of new CKD cases develop from diabetes and high blood pressure

Tang undergoing a four-hour dialysis treatment at the National Kidney Foundation in Petaling Jaya

Consistent exercise can help to prevent kidney disease

LAST year, there were 4,000 new patients with kidney failure in the country who needed dialysis treatment, according to the National Kidney Foundation.

Globally, more than 500 million individuals or about 1 in 10 adults have some form of chronic kidney disease.

CKD is when the kidneys can no longer eliminate bodily waste because of several factors — such as infections or underlying chronic diseases like high blood pressure and diabetes.  

According to the NKF, the number of CKD patients in need of dialysis increases every year, with 24,000 on treatment last year.

Besides the growing number of patients, what is even scarier is that many people are unaware that their kidneys are damaged until it is too late.

“The signs and symptoms will only appear in later stages. It’s a silent killer, but preventable if the public is willing to make some simple changes in their lifestyle,” says NKF honorary secretary Dr JD John.

A sedentary lifestyle and bad eating habits are the two main culprits of kidney failure.

“Lack of exercise and eating too much fast food or processed food as well as sweetened drinks can lead to various illnesses, such as high blood pressure and diabetes. More than 60 per cent of new cases develope from high blood pressure and diabetes,” says Dr John who adds that kidney disease can also develop from infection, inflammation of blood vessels in the kidneys, kidney stones and cysts.

Other possible causes include prolonged consumption of pain relievers, alcohol or drugs including prescription medication.

“Taking questionable or unauthorised supplements (like those not approved by the Health Ministry) or slimming pills can also have an impact on one’s kidneys,” he says.   

Dr John says healthy individuals just need to take five simple steps to protect themselves.

These are:
1. Practise good eating habits (lower the fat, salt and sugar content in your diet and add more fibre, fruit and vegetables), and a healthy lifestyle (stop smoking!).
2. Exercise three times a week, 30 minutes per session if possible.
3. Drink at least six glasses of water a day (helps your kidneys to function).
4. Don’t take unauthorised medications or supplements.
5. Go for health screening, especially those who fall under the high-risk groups (those who smoke or are obese, are over 50 years of age, those with a family history of diabetes, high blood pressure or kidney disease, as well as patients with diabetes, high blood pressure or other kidney diseases).
As for current patients, Dr John advises that they maintain a healthy diet, do low-impact exercises such as walking, and control their body weight, blood pressure, blood glucose and cholesterol levels.  

HIGH COST OF STAYING ALIVE

Kidney disease requires lifelong care and regular dialysis treatments. It is a burden both physically and financially, and many patients are unable to receive the proper care required due to the high cost of treatment. Also, patients are likely to lose their income as their health deteriorates.  

A patient undergoing a dialysis treatment requires more than RM2,000 for 13 sessions every month.

According to the Health Ministry’s Economic Evaluation of Centre Haemodialysis in 2004, the ministry spends between RM32,000 and RM34,000 per year on each person with kidney failure  for dialysis, related treatments and medicine.

Dr John says the NKF is among the non-profit organisations which provides affordable dialysis treatments and services.
“We assist patients by subsidising RM52 for each treatment. With an additional RM50 subsidy from the ministry, the patient will only pay RM50 per treatment or about RM650 per month.
“At present, the NKF needs RM31 million annually to help more than 1,000 patients at 25 centres nationwide. But with the number of new cases every year, the cost may be more in the near future,” he warns.

ON DIALYSIS, BUT LIVING LIFE

Being diagnosed with a chronic disease may leave some individuals feeling robbed of their lives, but not Tang Ah Nyah, 65.
Tang has been receiving dialysis treatment after she was diagnosed with CKD in 2006. Despite having to undergo three treatments per week (four hours per treatment) at the NKF Dialysis Centre in Petaling Jaya, Selangor, the bubbly mother of three is living life to the fullest.

“When I’m not on treatment, I will check on my family’s small advertising business which is now run by my 31-year-old son, Lim Yew Hsung.

“But mostly, I  hang out with my best friends. We go on outings, play mahjong and even enjoy makan-makan trips — I’m a food lover, but I eat in moderation now,” she says.

“I do low-impact exercises such as brisk walking to keep fit,” says the energetic Tang.

However, what she loves the most is helping other patients at the dialysis centre.

Fondly known as Aunty Tang at the centre, she has formed a small support group to help new patients, to foster a sense of self-esteem and to share experiences so they can face what lies ahead.
“Most patients who check into the centre for the first time are bewildered. Some even feel that having kidney disease is like ‘being on death row’.  
“So I teamed up with several  ‘senior’ patients to talk to the new ones and to share our knowledge and experiences. Based on what we’ve been through, we know it’s important to let them know that they are not alone and that everything is going to be fine as long as they stay positive. By doing that, I feel good about myself too,” she says, adding that she also helps to teach the patients handicraft.
The handicrafts are usually sold during NKF roadshows or exhibitions and provide the patients with some side income.

BLESSING IN DISGUISE

Recalling the moment when she discovered that she had CKD, Tang admits that she was devastated. However, she knew that she had no one to blame but herself. The kidney disease took its toll on her after she failed to manage her diabetes well.

“I’ve been a diabetic since I gave birth to Yew Hsung. I also suffered from hypertension. Despite that, I didn’t watch my diet or change my lifestyle. When my husband passed away in 1999, I was so busy running the family business and

taking care of my three children that I forgot to take care of my health,” she recalls.

Tang says by accepting her fate, she successfully  overcame her emotions and eventually, she coped with the situation.

“My main concern was money. I knew the cost of 13 dialysis treatments a month was too much for me. Luckily I was recommended for treatment at NKF at a subsidised rate,” she says.    

Tang used to pay RM180 per treatment, but now she pays RM50  under the subsidised dialysis treatment for the poor and needy offered by NKF.

Tang says the illness has helped her grow closer to her family, especially Yew Hsung.

“My son used to be playful and carefree, but he changed a lot after I was diagnosed with CKD. He has been taking care of me and making sure that I eat well and never miss my thrice-weekly treatments, especially after his elder sisters married,” she says.  

She also treasures life more now — not only hers, but that of people she cares about, including friends and patients at the dialysis centre.  

“It has become my habit to remind my children and the people around me to eat right, exercise and value their health,” she says.

“For me, having CKD is not the end of the world, but a blessing in disguise. It’s time to live life to the fullest and I want other patients to feel the same way,” she says.
 

Signs and symptoms

FEW people are aware of kidney damage until they have had a medical examination. Depending on the type of kidney disease, individuals may experience some of the following symptoms:

1. Discomfort or burning sensation when passing urine.
2. Blood in the urine.
3. A change in the frequency of urination.
4. Back pain.
5. Frequent urination especially during the night.
6. Swelling of the ankles.
7. Persistent puffiness around the eyes, particularly in the morning.

Fast facts

• There are more than 500 dialysis centres in the country run by government hospitals, private institutions and charity organisations.
• As of January, there are 15,078 patients on the national organ transplant waiting list. Of this number, 15,055 are waiting for kidney transplant.
• Details about NKF, its services and how you can help at www.nkf.org.my, or call 03-7954 9048.

CKD and nutrition

If detected and treated early, CKD may be slowed or stopped. Consulting a dietitian at the initial stages can reduce the consequence of malnutrition and improve the patient’s well-being.    
 
Protein

Protein intake needs to be adjusted during different stages of kidney disease to avoid overloading the kidneys. The initial recommendation is 0.6g/kg body weight. For patients who are malnourished, protein intake of 0.7g/kg body weight is recommended.

Calories

Energy requirement in CKD patients is similar to the general population. However, maintaining normal body weight is essential to control high blood pressure, diabetes and high cholesterol.

Sodium (salt)

Excessive amounts of salt can be harmful to a patient as it results in water retention and raises blood pressure. A patient should not consume more than one teaspoon (2.4g) of salt per day and avoid food which is high in sodium content such as sauces (soya sauce, ketchup, chilli sauce and seasoning), processed food (canned food, sausages, nuggets and burger patties etc.), food marinated with salt (salted fish or egg, anchovies, dried prawns, belacan, fermented shrimp and pickles, etc.), as well as instant or fast food.

Phosphate
Due to the decreased kidney function, a patient’s kidney may not be able to remove enough phosphate from the blood. This causes him or her to have a high blood phosphate level which can cause itchiness and loss of calcium from the bones, leading to osteoporosis.
High-phosphate foods that should be avoided include dairy products, kidney beans, split peas, nuts and peanut butter as well as beverages like hot chocolate, and alcohol and carbonated drinks.

Potassium

Usually people with CKD do not need to limit their potassium intake. However, if necessary, a patient will be recommended to adjust intake. Some high potassium foods are potato, squash, banana, orange, tomato, dried peas and beans.

Fluids

Fluid intake for CKD patients must be monitored. Besides water, other edible stuff in liquid forms at room temperature are also considered fluids, such as soups and ice cream.
To do this, patients should drink from prepared bottles so that they do not overdrink. Eat less sodium-laden food so you won’t feel thirsty.
Take candy or chewing gum to produce more saliva and wet your mouth with an ice cube if you are thirsty.

Sources: Healthy Eating & Chronic Kidney Disease (Stage 3 & 4) pamphlet by the NKF and the Malaysian Dietitians’ Association, the National Kidney Foundation and the National Transplant Centre.

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